Aging & Health A to Z

Home Care

Basic Facts & Information

Role of Health Care Professionals in Home Care

Your physician is the leader of an interdisciplinary healthcare team that may include nurses, therapists (such as: speech, physical, occupational, and respiratory), social workers, personal care aides, home medical equipment suppliers, and most importantly, informal caregivers (eg, family members). Although all team members are important, the physician is legally responsible for determining the older person’s health care needs. Physicians also develop, certify, and recertify the plan of care.

House Call Services

Current regulations allow physicians, nurse practitioners, and physician assistants to provide house call services. House calls can add to the healthcare provider’s knowledge of the circumstances and home setting of the older person, and may allow them to see and address problems that cannot be seen during an office visit. For example, there may be barriers (such as, cluttered hallways and no railings) that prevent the older person from functioning as well as he or she could. A home visit may also reveal caregiver burnout, elder abuse, or the use of medications that may get in the way of management or treatment of the disease. House calls also help older adults who may have difficulty getting around outside of the home because they do not have to travel to see the healthcare team.

Is Home Care Right for You?

Home care is especially useful for persons who need nursing, therapy, or aide services.  You may need help if you are dealing with one or more of the following:

• You have trouble getting around (for example, after a hospital stay or an accident)
• You have wounds that need to be cleaned, or you need  injections, or other treatments
• You need to learn more about your medical condition(s) and how to monitor them (for example, checking your blood pressure or your blood sugar)
• You need help with bathing, dressing and meal preparation
• You need care and emotional support when in the final stages of an incurable disease

Home care and house calls are needed for some patients for a limited amount of time, but others require house visits on an ongoing basis.

In order to qualify for Medicare coverage, the person must be “confined to home.”  Medicare describes confined to home as follows:

• You do not have to be bedridden to be considered confined to the home
• You should have a condition that makes it hard for you to leave home
• You are allowed to leave your home to:
  • See a healthcare professional
  • Go to a religious service
  • Occasional outings such as a walk around the block, to go to a family reunion, or other unique events as long as they are not on a regular basis

Limitations of Home care

Most older adults prefer to remain in their own home. However, situations and conditions may come up that make care in an institution or facility more appropriate. For example, caregivers may not be available to adequately address the needs of the older person. Similarly, caregiver burnout and stress may prevent continued safe care for the older person in the home. 

Some serious medical situations that require frequent testing, breathing treatments, or intravenous medications also may make care in an institution a better choice than home care. In some cases, the home setting itself may be a barrier to continuing home care. Unsafe neighborhoods, household troubles from alcohol or drug use, and not enough room for equipment or environmental modifications may make home care a poor or risky option. 

Finally, home care is not always the least expensive choice, and out-of-pocket costs may make ongoing home care unaffordable. Insurance coverage is more likely to cover care that is given in a nursing facility or other institutional setting. 

Home Assessment & Modification

Homebound patients often have health problems or disabilities in one or more areas of their health and functioning. Comprehensive geriatric assessment is particularly valuable in this situation. A comprehensive assessment can be used to establish the initial level of health and functioning, monitor the course of illness, and evaluate effects of treatments. Also, assessment in the home has some important advantages over office-based assessment.

Advantages of Home Assessment
The healthcare professional can see how the patient functions in their actual home environment.

This helps the healthcare professional determine if the home is safe and appropriate for the patient’s particular abilities and disabilities, or if changes need to be made. For example, the health care provider can assess the practical aspects of performing activities of daily living (ADLs) such as bathing or dressing. The healthcare professional can also evaluate the caregiver’s abilities to address the needs of the older person. The caregiver’s needs for counseling, training, support, and education can also be identified and addressed.

There are two types of changes (modifications) that can be made to ensure that the home is safer for the older adult.

• Environmental modifications can be recommended to improve function.
  For example, a hand-held shower, a shower seat, bathtub grab-bars, or a bedside commode might improve the patient’s quality of life and ability to function. Barriers to wheelchairs and walkers (such as,door sills) can be identified and removed. Chair lifts and outdoor ramps can be recommended to help patients manage stairs. The assessment might also include an occupational therapy consultation. This can be useful in identifying other personal care and assistive devices for performing ADLs and housekeeping chores. A number of home safety checklists are also available to help with home assessment.

• Assistive Technology to improve home safety can also be considered.
  These include necklace or wrist radio devices to call for help. There are also emergency response systems that require a person to push a button by a specified time each day to avoid triggering an emergency response or checkup phone call.
  
  Healthcare professionals are finding that portable or mobile testing technology (home diagnostics), including x-rays and electrocardiograms (ECGs), are available in most areas. Hand-held laboratory devices are also becoming more common. These home diagnostics allow for a much more comprehensive medical evaluation to be done in the home.

Last Updated: March 2013
Posted:  March 2012